“Persistent Juvenile” T-Wave Pattern May Not Be Persistent: Case Series and Literature Review

Walsh, Barbara C.; Smith, Stephen W.

doi:10.1016/j.jemermed.2015.06.064

Cited by 2 publications

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References 44 publications

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“…When this otherwise "juvenile" pattern is seen in an adult, it has been termed the "persistent juvenile T wave pattern." 64 Figure 5 Juvenile T wave pattern is more common in black patients This pattern was recognized as early as 1946, found predominantly in black subjects, and especially women, with prevalence of 2.1% to 4.6%. 65 , 30 , 44 66 The older literature can often be difficult to interpret, as many studies term a variety of patterns (i.e.…”

Section: The Persistent Juvenile T Wave Patternmentioning

confidence: 99%

Distinctive ECG patterns in healthy black adults

Walsh

Macfarlane

Prutkin

et al. 2019

Journal of Electrocardiology

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Six ECG patterns are found more frequently in healthy black adults than in whites. These patterns are presumably benign, but also may resemble those of malignant disease. 1) Healthy black adults show higher QRS voltage, and more often meet ECG criteria for left ventricular hypertrophy (LVH). Associated repolarization abnormalities can produce ST segment elevation (STE) that resemble ST elevation MI (STEMI). 2) The pattern of benign anterior STE, seen often in males, is more common in black subjects. Similar to LVH, this pattern may falsely suggest STEMI. 3) Both early repolarization (ER) and benign inferolateral STE are more common in black patients. Although they may convey a higher risk of fatal arrhythmias or cardiac death in white populations, it does not appear that black subjects with these patterns show a similar risk.4) The persistent juvenile T wave inversion pattern shows asymmetric T wave inversion (TWI) in V1-V4, without ST segment deviations. It is most common in black females, and is considered benign. However, this pattern can also resemble the anterior TWI of arrhythmogenic right ventricular cardiomyopathy (ARVC). 5) A pattern of anterior TWI with associated J point elevation is a common finding in the black population, especially athletes. It could suggest hypertrophic cardiomyopathy, but can be presumed to be a benign finding in black athletes, when TWI is limited to V1-V4 and preceded by J point elevation. 6) TWI in the lateral precordial leads, usually associated with end-QRS slurring or notches is seen much more often in apparently healthy black subjects than white subjects. Unlike the anterior TWI pattern, however, it cannot be presumed benign.In conclusion, awareness of these ECG patterns may help to avoid unnecessary diagnostic or therapeutic interventions, but also encourage appropriate investigations.

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Section: The Persistent Juvenile T Wave Patternmentioning

confidence: 99%

Distinctive ECG patterns in healthy black adults

Walsh

Macfarlane

Prutkin

et al. 2019

Journal of Electrocardiology

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T-wave inversions on ECG as primary manifestation of Hashimoto's disease

2016

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A middle-aged Hispanic woman presented to the emergency department (ED) reporting of acute new onset pressure-like chest pain developed at rest. It was radiated to the right arm and associated with malaise. Initial ECG demonstrated T-wave inversions (TWIs) in all anterior and lateral leads. Electrolytes, serial cardiac troponin and D-dimer were all normal. Comprehensive transthoracic echocardiogram and nuclear stress test did not reveal a cardiac cause of her symptoms.Serum thyroid-stimulating hormone was markedly elevated (207 mIU/L) and free thyroxine was low (FT4 0.07 ng/dL), consistent with severe primary hypothyroidism. Thyroperoxidase (TPO) antibodies were positive. Therapy with levothyroxine was started. No other cause of the TWIs was identified. A repeat ECG obtained 8 weeks later showed partial resolution of the TWIs. Our observations indicate that Hashimoto's disease is the most likely primary cause of this patient's extensive and profound TWI, which improved after thyroid replacement therapy.

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“Persistent Juvenile” T-Wave Pattern May Not Be Persistent: Case Series and Literature Review

Cited by 2 publications

References 44 publications

Distinctive ECG patterns in healthy black adults

Distinctive ECG patterns in healthy black adults

T-wave inversions on ECG as primary manifestation of Hashimoto's disease

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